It is during this time of year that I see a lot of children and adolescents for pre-participation school physicals.  In the United States pre-participation physicals are mandated for most school athletes. This means that a lot of children are visiting their PCP or going to an urgent care to get a physical performed. 

One of the primary reasons for the pre-participation physical is to detect cardiovascular disease and thereby decrease the incidence of sudden cardiac death in athletes. But has the school physical actually been shown to decrease the incidence of sudden cardiac death?

It might surprise you that there is very little data and no randomized trials on the impact screening programs have on the incidence of sudden cardiac death (SCD) in athletes. Much of the rationale for these physicals is based on observational data or expert opinion. While the data does seem to demonstrate improved outcomes with screening, the absolute benefit (based on the overall low event rates) is small.

For example in one analysis of 134 cases of sudden cardiac death in high school and college athletes in the United States, cardiovascular abnormalities were suspected by standard history and physical examination in only 3 percent. This means that the vast majority of athletes that died suddenly had a normal physical exam.

In another series from a Italian co-hort who underwent routine pre-participation screening that included an ECG, the prevalence of markedly abnormal ECG patterns suggestive of significant structural heart disease was <5 percent.

There are little data that evaluate the efficacy of screening programs on outcomes. The only positive data come from an observational study from Italy (where athletic screening has been mandatory since 1982) in which all SCD in athletic and nonathletic populations between the years 1979 and 2004 was recorded, with the annual incidence of SCD in athletes decreasing from 3.6/100,000 person-years in 1979 to 1980 to 0.4/100,000 person-years in 2003 to 2004 (89 percent reduction). Notably, there was no change in the incidence of SCD among non-athletes over the same time period.

While I am not advocating that these screening programs be stopped or that you should not screen your child for cardiovascular disease it is important to realize that these exams will not decrease the risk of sudden cardiac death to zero. ​

The majority of us make New Year's Resolutions at the beginning of every year and many of these resolutions are health related. Now that we have passed the half way mark in 2016 it is time to take stock of how you are doing. 

The following are a few health checkpoints that you can use to assess how you are doing from a health standpoint. This list is a starting point and is not exhaustive. 

1. What are you drinking? Most of us know that we probably should drink more water and less soda. I frequently get questions about how much water to drink. A common myth out there is that we should drink 8 glasses of water a day. This recommendation doesn't make sense as we are not all the same size and we don't all sweat or perspire the same. There are several keys to monitor hydration. First is to simply monitor our level of thirst. Our urine is also a key indicator. Clear or slightly yellow urine indicates good hydration. It also make intuitive sense that the more well hydrated you are the more you will urinate. 

2. Eat Two meals/day within an 8 hours window: Something I have done extensively is intermittent fasting by eating two times per day. The benefits of fasting are significant and many Americans eat the most in evening. By eliminating a meal or the evening meal it may be easier to lose weight and control diabetes. 

3: Weight Loss/Clean up diet: Most Americans should lose weight. An ideal BMI is around 23. For the majority of my patients I also recommend checking an insulin level to see how they tolerate carbohydrates. If the Insulin level is elevated and/or the fasting blood sugar is above 85 then a lower carbohydrate diet high in healthy fats is recommended. 

4: Sleep: There is a lot of evidence that we should be getting 8 hours of sleep per night. Getting significantly less or more is associated with insulin resistance, obesity, and cardiovascular disease. 

5. Sit less and walk more: The majority of us are familiar with the recommendation to stand and walk more for our cardiovascular health. High intensity exercise is also important. 

6. Stress Reduction: Poor sleep and elevated levels of stress facilitate the release of stress hormones and adrenaline. These hormones are pro-inflammatory and associated with diabetes and obesity and poor cardiovascular health. Most people could benefit from learning 3 ways to help them deal with stress such as relaxation techniques and mindfulness. 

7. Vitamin D/Sun exposure: I recommend that everyone get their Vitamin D level checked because the majority of us don't get enough healthy sun exposure. Vitamin D is associated with many health benefits and is associated with cardiovascular health. 

In my practice I work with patients on all these items and more. Some have made tremendous progress. Of course, these are general recommendations and are not right for everyone. See your doctor if you need further advice.